Liver Path II

Question 1

centrilobular

Answer 1

zone 3

necrosis - with right heart failure

Question 2

periportal

Answer 2

zone 1

necrosis with phosphorus, eclampsia, mushroom toxicity

Question 3

fulminant masive necrosis of liver

Answer 3

usually fatal

amanita mushroom

Question 4

bridging fibrosis

Answer 4

portal to portal

seen with trichrome stain

Question 5

fulminant liver failure

Answer 5

acute liver failure

acute liver illness with enceophalopathy and coagulopathy within 26 weeks of initial liver injury

massive hepatocyte necrosis >80%

acetaminophen toxicity, drug rxns, toxins, viruses

ICU and liver transplant

Question 6

chronic liver failure

Answer 6

loss of 80-90% liver function

jaundice, edema, forgetful (hyperammonia)

fetor hepatis - smelly breath

parotid gland enlargement

PT time - factor VII

Question 7

hepatic encephalopathy

Answer 7

hyper ammonia

Question 8

PT time

Answer 8

increased bc of factor VII decrease in chronic liver failure

Question 9

nodules of liver

Answer 9

can be palpable

Question 10

12th leading cause of death

Answer 10

cirrhosis

Question 11

cirrhosis characteristics

Answer 11

bridging fibrosis
parenchymal nodules
disruption of enter liver - diffuse

Question 12

nodularity of cirrhosis

Answer 12

from regeneration of hepatocytes

Question 13

cirrhosis

Answer 13

irreversible
-rarely - regression can occur

but do still have risk of hepatocellular carcinoma

Question 14

diagnosis of cirrhosis

Answer 14

see regenerating hepatocytes

Question 15

etiology of cirrhosis

Answer 15

hep C - alcohol - cryptogenic

Question 16

stellate cells

Answer 16

to myofibroblasts - by PDGFR and TNF
-induce ECM deposition and cirrhosis**

kupffer cells - cytokines stimulate fibrogenesis in stellate cells

collagen in space of disse

Question 17

biliary channels

Answer 17

rate limiting step in bilirubin excretion - lost in cirrhosis

Question 18

anorexia, weight loss, fatigue, weakness

Answer 18

cirrhosis

Question 19

PDGF and TNF

Answer 19

activate stellate cells

Question 20

endothelin 1

Answer 20

stimulate contraction of stellate cells

Question 21

TGF-beta

Answer 21

stimulate fibrogenesis

Question 22

canonical principle

Answer 22

necrosis of hepatocytes
to myofibroblasts

leads to liver fibrosis

Question 23

NO

Answer 23

vascular relaxation and stellate cell apoptosis

Question 24

angiogenesis in cirrhosis

Answer 24

increased sinusoid vessls with cirrhosis
-micro and macronodules form

could theoretically serve as portal pressure reducing shunts

Question 25

acute liver injury

Answer 25

apoptosis of hepatocytes minor - can regenerate major - loss of hepatocytes canals of hering - liver progeneritor cells genesis signaling - hedgehog, Wnt, hedgehog

Question 26

portal HTN

Answer 26

with fibrosis and sinusoid remodeling also low NO, increased vasoconstrictors, and endothelial dysfunction

Question 27

micronodular

Answer 27

less than 3mm

Question 28

macronodular

Answer 28

greater than 3mm

Question 29

nodules

Answer 29

regenerating hepatocytes

Question 30

bridging fibrosis

Answer 30

connect portal triads and centrilobular hepatocytes | -create islands of regeneration

Question 31

liver cords two cells thick

Answer 31

presumptive of regeneration

Question 32

portal HTN

Answer 32

increase portal venous pressure 8-10mmHg or hepatic vein/portal vein gradient >5mmHg see collaterals open - esophageal varices, hemorrhoids, caput medusa

Question 33

portal HTN path

Answer 33

2/3 structural - sinusoid resistance 1/3 dynamic - increased portal venous flow -uncleared got bacteria - produce NO

Question 34

result of portal HTN

Answer 34

ascites portosystemic shunts congestive splenomegaly hepatic encephalopathy

Question 35

pre-hepatic portal HTN

Answer 35

portal or splenic vein occlusion

Question 36

intra-hepatic portal HTN

Answer 36

pre-sinusoid - schistosomiasis, sarcoidosis sinusoidal - cirrhosis, alcoholi hepatitis post-sinusoid - veno-occlusive disease, pyyrolizidine

Question 37

pyrollizidine

Answer 37

ca lead to post-sinusoid intrahepatic portal HTN

Question 38

post -hepatic portal HTN

Answer 38

right side HF constrictive pericarditis hepatic vein outflow obstruction - budd chiari - 2 veins needed**

Question 39

most common cause of portal HTN

Answer 39

cirrhosis

Question 40

falciform ligament with abdominal wall collaterals

Answer 40

caput medusa

Question 41

most problematic shunt

Answer 41

esophageal varices

Question 42

esophageal and azygous veins

Answer 42

esophageal varices

Question 43

between superior rectal vein and lower rectal veins

Answer 43

hemorrhoids

Question 44

between paraumbilical veins and abdominal epigastric veins

Answer 44

caput medusa

Question 45

between colic veins and retroperitoneal veins

Answer 45

portosystemic shunt

Question 46

splenomegaly

Answer 46

can occur in splenomegaly -hypersplenism leads to pancytopenia

Question 47

gamna gandy bodies

Answer 47

microscopic foci of fibrotic iron laden nodules in splenic parenchyma -with splenomegaly due to portal HTN

Question 48

ascites

Answer 48

excess fluid in abdomen commonly due to cirrhosis

Question 49

path of ascites

Answer 49

sinusoid HTN sodium and water retention vasodilation of splanchnic circulation - RAAS system - increased ADH

Question 50

peritoneal ascites

Answer 50

carcinoma - tuberculosis see high protein

Question 51

non-peritoneal ascites

Answer 51

cirrhosis and heart failure see low protein (but albumin still in ascitic fluid

Question 52

spontaneous bacterial peritonitis

Answer 52

ascites pt with fever, abdominal pain E. coli and s. pneumonia

Question 53

hydrothorax

Answer 53

more common on right - right pleural effusion can occur with ascites